Challenges and opportunities for implementing evidence-based antenatal care in Mozambique: a qualitative study

Biza, Adriano; Jille-Traas, Ingeborg; Colomar, Mercedes; Belizán, María; Harris, Jenny; Crahay, Beatrice; Merialdi, Mario; Nguyen, My Huong; Althabe, Fernando; Alemán, Alicia; Bergel, Eduardo; Carbonell, Alicia; Chavane, Leonardo; Delvaux, Thérèse; Geelhoed, Diederike; Gülmezoglu, Metin; Malapende, Celsa Regina; Melo, Armando; Osman, Nafissa; Widmer, Mariana; Temmerman, Marleen; Betrán, Ana Pilar

doi:10.1186/s12884-015-0625-x

Cited by 51 publications

(82 citation statements)

References 18 publications

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“…Factors pointed by this review affecting the use of the CDK are not very different from barriers and facilitators found in other studies assessing the utilization of other health services within ANC [7, 29, 30]. In several African and Asian countries, it is a common practice among pregnant women to seek for traditional medication or TBAs as first line providers since they perceive facility birth as less convenient.…”

Section: Discussionmentioning

confidence: 62%

Supply kits for antenatal and childbirth care during antenatal care and delivery: a mixed-methods systematic review, the qualitative approach.

et al. 2017

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Antenatal care reduces maternal and perinatal mortality and morbidity through the detection and treatment of some conditions, but its coverage is less than optimal within certain populations. Supply kits for maternal health were designed to overcome barriers present when providing care during pregnancy and childbirth particularly to women from underserved population.We conducted a mixed-methods systematic review on the use of supply kits. This manuscript presents the findings from qualitative studies that reported barriers, facilitators, and user’s recommendation in the adoption and implementation of any type of kit designed to be used during pregnancy or childbirth.This review included eight studies, and seven were implemented in developing countries. Most studies assessed the implementation of clean delivery kits to be used during labour and delivery, and contributed to gain insights into factors that may hinder or foster the use of kits.Clean delivery kits were conceived to cope with barriers related mainly to access. The most important barrier identified were those related to the socio-cultural and the lack of knowledge dimension such as who held the decision-making authority in the household, as well as popular beliefs behind the idea that birth preparation could bring bad luck, may prevent clients from adhering to their use. In addition, financial constraints and limited understanding of the instructions of use were accessibility barriers found. On the other hand, once used, clean delivery kits for maternal health were accepted by women and health workers. Convenience, hygienic components, and avoidance of delays in receiving care were viewed as satisfactory features.Supply kits are mostly affordable and easily deployable. Increasing awareness among the population about the offered kits and providing information on their benefits emerges as a critical step to foster use in settings where kits are available. Implementation of this strategy requires low complexity resources and could make the use of kits an accepted alternative to increase the use of evidence-based interventions and thus improve quality of care during pregnancy, childbirth and neonatal period mainly at the community level in low income countries and remote areas with low access.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-017-0299-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 62%

Supply kits for antenatal and childbirth care during antenatal care and delivery: a mixed-methods systematic review, the qualitative approach.

et al. 2017

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“…Health programmes should involve communities by disseminating information about the importance of early ANC. Other studies reported that fear of witchcraft [31,32], religion[34], education [31,34] and economic security[31,32] are associated with access to ANC. Educating and economically empowering women could improve early access to ANC and utilization of health services.…”

Section: Discussionmentioning

confidence: 99%

Comparative cost-effectiveness of Option B+ for prevention of mother-to-child transmission of HIV in Malawi

Tweya

Keiser

Haas

et al. 2016

Aids

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Objective To estimate the cost-effectiveness of prevention of mother to child transmission (MTCT) of HIV with lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women (‘Option B+’) compared to ART during pregnancy or breastfeeding only unless clinically indicated (‘Option B’). Design Mathematical modelling study of first and second pregnancy, informed by data from the Malawi Option B+ programme. Methods Individual-based simulation model. We simulated cohorts of 10,000 women and their infants during two subsequent pregnancies, including the breastfeeding period, with either Option B+ or B. We parameterised the model with data from the literature and by analysing programmatic data. We compared total costs of ante-natal and post-natal care, and lifetime costs and disability-adjusted life-years (DALYs) of the infected infants between Option B+ and Option B. Results During the first pregnancy, 15% of the infants born to HIV-infected mothers acquired the infection. With Option B+, 39% of the women were on ART at the beginning of the second pregnancy, compared to 18% with Option B. For second pregnancies, the rates MTCT were 11.3% with Option B+ and 12.3% with Option B. The incremental cost-effectiveness ratio comparing the two options ranged between about US$ 500 and US$ 1300 per DALY averted. Conclusion Option B+ prevents more vertical transmissions of HIV than Option B, mainly because more women are already on ART at the beginning of the next pregnancy. Option B+ is a cost-effective strategy for PMTCT if the total future costs and lost lifetime of the infected infants are taken into account.

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“…Therefore, the proposal of this study, which does not only allow to assess the prevalence of HIV and STI, in a population group of pregnant women, but also to verify whether the norms for the diagnosis and treatment of these infections are followed. The analysis of this situation will allow the adjustment of the standards of conduct of health personnel, if these are not in accordance with those recommended at national and international level [87][88][89][90][91][92][93][94][95].…”

Section: Resultsmentioning

confidence: 99%

Intellectual Corruption in Modern Science: A Case Study

2019

JCRC

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Sexually transmitted infections are among the most common public health problems worldwide. Female and male infertility, mother to child transmission, causing miscarriages or congenital disease, and increased risk for Human Immunodeficiency Virus infection (HIV) are some of their consequences. In Sub-Saharan Africa countries, such as Mozambique, the prevalence of these infections is high, women being those who carry the higher burden. Thus we developed this cross-sectional study with objective of characterizing some sexually transmitted infections, HIV infection, syphilis and trichomoniasis in pregnant women, verifying if their management was in accordance with guidelines and recommendations in the country and identifying practice, Knowledge and associated risk factors. Samples were collected from 253 pregnant women attending Centro de Saúde de Maxixe. Vaginal samples were obtained and observed microscopically by wet mount and direct microscopic examination (Trichomonas vaginalis). HIV antibody testing was performed with the tests Determine HIV-1/2 and Uni-GoldTM and against, T. pallidum by RPR, SD BIOLINE Syphilis 3.0 and Determine TP tests in plasma samples. In this study, 11.1% of the pregnant women were infected with HIV, 2.8% with active syphilis, 5.1% with Trichomonas vaginalis and 9.1% with yeast. Antibodies against T. pallidum were identified in 8,3% of these women. In relation to HIV, 7, 5% of them were new cases. Samples were taken from 253 pregnant women attending ante-natal outpatient consultation at the health centre, which were informed about the nature of the study and submitted to a semi-structured interview after signing the free informed consent. In this study, the inconsistency on condoms use and the existence of multiple partners by the participants contributing for these infections transmission. Participants have shown that they had information about these infections modes of transmission, as also which measures to use to prevent them. A significant number of women present with any symptom related to infections that were diagnosed to them, proving that the use of syndrome approach in vaginal discharge must be given some thought in relation to its value in this situation. The data obtained in this study shows that some gaps also exist in the prenatal care clinics of this Centre, from routine procedures that are not performed in accordance with MISAU recommendations. The high prevalence of some STI found in this population, their risk behavior, together with the non-observance of some guidelines in the management of those infections by the health personal very worrying. The implementation of a teaching program on quality control, prevention and management of these infections by the health professional seems to us to be of utmost importance, so these can act in accordance with the present guidelines and transmit correct information to the pregnant women who attend prenatal care.

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Challenges and opportunities for implementing evidence-based antenatal care in Mozambique: a qualitative study

Cited by 51 publications

References 18 publications

Supply kits for antenatal and childbirth care during antenatal care and delivery: a mixed-methods systematic review, the qualitative approach.

Supply kits for antenatal and childbirth care during antenatal care and delivery: a mixed-methods systematic review, the qualitative approach.

Comparative cost-effectiveness of Option B+ for prevention of mother-to-child transmission of HIV in Malawi

Intellectual Corruption in Modern Science: A Case Study

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